One-Stage Repair of Extensive Chronic Aortic Dissection Using the Arch-First Technique and Bilateral Anterior Thoracotomy

Kouchoukos, Nicholas T.; Masetti, Paolo; Mauney, Michael C.; Murphy, Michael C.; Castner, Catherine F.

doi:10.1016/j.athoracsur.2008.07.059

Cited by 58 publications

(36 citation statements)

References 31 publications

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“…19 Kouchoukos et al 20 introduced the "arch-first" procedure and bilateral anterior thoracotomy incision to treat chronic type A dissection. The 1-stage arch-first procedure was also a safe and suitable alternative for patients with chronic dissection.…”

Section: Sun Et Al Surgery For Type a Dissectionmentioning

confidence: 99%

“…Moreover, the unilateral SCP procedure is also a factor in surgical outcome. 20 This procedure provides physiological antegrade perfusion of the brain throughout the entire procedure, so the risk of cerebral atheroembolization is diminished. This was demonstrated by the low prevalence of cerebral complications in the present study (2.4% of patients with stroke).…”

Section: Sun Et Al Surgery For Type a Dissectionmentioning

confidence: 99%

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Total Arch Replacement Combined With Stented Elephant Trunk Implantation

et al. 2011

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Background-Appropriate surgical management of type A dissection is a critical factor for achieving satisfactory outcome, but the choice of optimal procedure is controversial. We retrospectively reviewed our experience with aortic arch replacement for type A dissection involving the arch. Methods and Results-Excluding 14 cases of subtotal or total aortic replacement, 411 of 544 patients with type A dissection (stented elephant trunkϭ291, conventional surgical repairϭ120) underwent aortic arch replacement between January 2003 and September 2008. In-hospital mortality was 3.09% (9 of 291) for stented (acuteϭ4.73%, 7 of 148; chronicϭ1.40%, 2 of 143) and 5.00% (6 of 120) for conventional repairs (acuteϭ6.06%, 4 of 66; chronicϭ3.70%, 2 of 54). Spinal cord injury was 2.41% (7 of 291) in the stented and 0.83% (1 of 120) in the conventional group. The overall prevalence of stroke was 1.95% (8 of 411) (stentedϭ2.41%, 7 of 291; conventionalϭ0.83, 1 of 120). Secondary intervention was 2.34% (5 of 214) for acute dissection (stentedϭ1 and conventionalϭ4; Pϭ0.031) and 3.05% (6 of

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Section: Sun Et Al Surgery For Type a Dissectionmentioning

confidence: 99%

Section: Sun Et Al Surgery For Type a Dissectionmentioning

confidence: 99%

Total Arch Replacement Combined With Stented Elephant Trunk Implantation

et al. 2011

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“…This procedure can offer adequate exposure of the aortic arch and cervical vessels while minimizing the risk of injury and infection of the tracheostoma; however, the risk of reoperation for bleeding and postoperative respiratory complications is very high. According to Kouchoukos et al [8,9] reoperation for bleeding was required in 10 and 17% of all cases, and mechanical support for more than 72 h was required in 42 and 46% of patients, with a mean duration of ventilatory support of 9.4 and 12 days, respectively. In addition, as our case involved a ''subacute'' aortic dissection, the risk of bleeding and respiratory complications appeared to be much higher than the reported risk.…”

Section: Discussionmentioning

confidence: 98%

“…Kouchoukos et al [7][8][9] reported the use of bilateral anterior thoracotomy for a single-staged repair of extensive thoracic aortic ''true'' aneurysms or extensive ''chronic'' aortic dissections with hypothermic circulatory arrest and an arch-first technique. This procedure can offer adequate exposure of the aortic arch and cervical vessels while minimizing the risk of injury and infection of the tracheostoma; however, the risk of reoperation for bleeding and postoperative respiratory complications is very high.…”

Section: Discussionmentioning

confidence: 99%

Total arch replacement for a subacute type A dissection in a patient with a terminal tracheostoma after total laryngectomy: report of a case

et al. 2011

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Standard full median sternotomy for total arch replacement in tracheostomy patients may lead to mediastinitis and graft infection. Several approaches for typical cardiac surgery, including a T-shaped sternotomy, have been used in patients with both terminal and transient tracheostomas; however, these procedures offer inadequate surgical exposure of the arch vessels. We herein report the case of a 67-year-old man with a subacute type A aortic dissection with a terminal tracheostoma after total laryngectomy, who successfully underwent total arch replacement by a fourth intercostal thoracotomy performed using an anterior bilateral approach and the arch-first technique. To our knowledge, this is the first report of a case of total arch replacement in a patient with subacute aortic dissection and a terminal tracheostoma.

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“…They argued that this technique is 'less morbid' than conventional aortic replacement through an extended surgical approach, like hemi-clamshell or clamshell incision, emphasizing that none of their patients suffered respiratory complications (reintubation or tracheostomy) and comparing it with the 17% rate of those complications as reported by Kouchoukos after clamshell surgery [17]. Admittedly, the results presented by Roselli et al speak for excellent intensive care at Cleveland, but they can also be partially fortunate and fortuitous because the recent observation of more than 1200 elective patients who underwent complete arch replacement through median sternotomy at 11 European centres revealed a need for reintubation and/or tracheostomy with a rate of 21% as one of the most frequent postoperative complications [18].…”

Section: Discussionmentioning

confidence: 99%

Open aortic arch surgery in chronic dissection with visceral arteries originating from different lumens

Urbanski

Bougioukakis

Deja

et al. 2015

Eur J Cardiothorac Surg

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OBJECTIVES: Surgical management of chronic aortic dissection is controversial, especially when the dissection extends into the abdominal aorta in which the visceral arteries originate from different lumens and is combined with aortic arch pathology necessitating surgery. The aim of the study was to evaluate the results of open surgery in this complex aortic pathology. METHODS:Between June 2002 and 2015, a total of 17 patients (median age 57, range 32-76 years) necessitating complete arch replacement presented complex chronic dissection of the thoraco-abdominal aorta with the visceral arteries originating from different lumens. Fourteen patients (82%) had had previous cardiac surgery, which was performed on the proximal aorta in all but one because of acute type A dissection. Nine patients without considerable dilatation of the descending aorta received aortic arch replacement with distal resection of the dissection membrane, and 8 patients with progressive dilatation of the thoracic aorta underwent aortic arch and descending aorta replacement via clamshell approach. RESULTS:No early (defined as 30-day, 90-day and in-hospital period) deaths, strokes or spinal cord injuries occurred. Only 1 patient (6%) presented temporary neurological dysfunctions (delirium, agitation), which resolved completely before discharge, and an injury of the recurrent laryngeal nerve was documented in 2 patients (12%). Temporary dialysis was necessary in 1 case. The follow-up was complete for all patients. All but one patient, who died due to leukaemia 23 months after surgery, were alive at the last follow-up (median duration 33 months, range 2-118 months). No patient needed a reoperation or an intervention on the thoracic and/or abdominal aorta. Moreover, no noticeable progression of the chronic dissection in the downstream aorta was documented in any patient. CONCLUSIONS:The results after conventional aortic arch repair with distal resection of the dissection membrane and, if necessary, with replacement of the progressively dilated chronic dissected thoracic aorta can offer excellent results in experienced hands and, therefore, this technique may be considered as a preferable option for surgical treatment of chronic aortic dissection with involvement of the aortic arch and the visceral arteries originating from different lumens.

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One-Stage Repair of Extensive Chronic Aortic Dissection Using the Arch-First Technique and Bilateral Anterior Thoracotomy

Cited by 58 publications

References 31 publications

Total Arch Replacement Combined With Stented Elephant Trunk Implantation

Total Arch Replacement Combined With Stented Elephant Trunk Implantation

Total arch replacement for a subacute type A dissection in a patient with a terminal tracheostoma after total laryngectomy: report of a case

Open aortic arch surgery in chronic dissection with visceral arteries originating from different lumens

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